Department of Plastic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
J Pak Med Assoc. 2024 Apr;74(4 (Supple-4)):S136-S144. doi: 10.47391/JPMA.AKU-9S-21.
The aim of our study was to assess the advantages and limitations of robotic technology in diverse reconstructive procedures.
A scoping review was conducted in Oct'23, on published studies from 2013 to 2023, focussing on robotic-assisted free flap harvesting. Three databases Ovid-MEDLINE, Scopus, and PubMed were searched. Original research studies reporting robotic-assisted free flap harvest were included. Studies on lesion excision, microvascular anastomosis, local flap harvest, roboticassisted flap inset, review articles, abstract-only studies, non-English documents, and animal studies were excluded from this review.
Sixteen studies met the inclusion criteria out of a total of 318, searched initially. These studies included a total of 128 patients, who underwent robotic-assisted free flap harvest for the reconstruction of various defects, with 140 free flaps harvested. The most common flaps harvested by robotic technique were deep inferior epigastric artery perforator (DIEP) flap 120 (85.7%), radial forearm free (RFF) flap 11 (7.9%), latissimus dorsii flap 4 (2.9%), rectus abdominus flap 4 (2.9%), and omental flap 1 (0.7%). Breast reconstruction was the major procedure done i.e. 120 (85.7%) followed by head and neck 11 (7.9%) and limb defects 9 (6.4%) reconstruction procedures. The reported clinical outcomes were acceptable in all the studies with a 99% flap success rate and minimal complications. Variability in operating time was observed depending upon surgical steps undertaken with robotic systems.
This scoping review highlights the role of robotic-assisted free flap harvesting in plastic surgery and its potential benefits on clinical outcomes, due to its high precision and minimal invasiveness. However, challenges like cost effectiveness, resource distribution and learning curve are there.
本研究旨在评估机器人技术在各种重建手术中的优势和局限性。
2023 年 10 月进行了一项范围界定综述，检索了 2013 年至 2023 年期间发表的关于机器人辅助游离皮瓣采集的研究。使用 Ovid-MEDLINE、Scopus 和 PubMed 三个数据库进行检索。纳入报告机器人辅助游离皮瓣采集的原始研究。排除病变切除、微血管吻合、局部皮瓣采集、机器人辅助皮瓣插入、综述文章、仅摘要研究、非英文文献和动物研究的文章。
共检索到 318 篇文章，其中 16 篇符合纳入标准。这些研究共纳入 128 例患者，他们接受机器人辅助游离皮瓣采集以重建各种缺陷，共采集 140 个游离皮瓣。机器人技术采集的最常见皮瓣为腹壁下动脉穿支皮瓣 120 例（85.7%）、桡侧游离皮瓣 11 例（7.9%）、背阔肌皮瓣 4 例（2.9%）、腹直肌皮瓣 4 例（2.9%）和网膜皮瓣 1 例（0.7%）。乳房重建是最主要的手术方式，即 120 例（85.7%），其次是头颈部 11 例（7.9%）和四肢缺损重建 9 例（6.4%）。所有研究的临床结果均可接受，皮瓣成活率为 99%，并发症最小。根据机器人系统所采取的手术步骤，手术时间存在差异。
本范围界定综述强调了机器人辅助游离皮瓣采集在整形外科学中的作用及其在临床结果方面的潜在益处，这归因于其高精度和微创性。然而，也存在成本效益、资源分配和学习曲线等挑战。
